When articles about the world’s first head transplant began popping up in news feeds, Emory Neuroethics Program director Karen Rommelfanger thought it must be a hoax.

There hadn’t been any papers published about the procedure or any serious discussion of practice operations on animals or human corpses. Just a few still photos and lots of online speculation. Most of the conversations were centered on the gross-out factor of the operation or the very high likelihood that such a procedure would fail. Very few were talking about the many ethical concerns a head transplant would raise.

But as news spread and it became clear that the planned operation in China was not a hoax, Rommelfanger and other neuroethicists decided it was time for a serious discussion about the ethical implications of head transplants — regardless of whether the procedure is possible now, years or decades in the future, or never.

“This is a real procedure they’re going to attempt. Whether it’s going to work is a whole other issue, but they are going to do this and have the funding to do it,” says Rommelfanger.

And Emory was the right institution to lead the discussion. The university is home to the American Journal of Bioethics (AJOB) – Neuroscience, the official journal of the International Neuroethics Society.

Paul Root Wolpe, Asa Griggs Candler Professor of Bioethics at Emory and editor-in-chief of AJOB-Neuroscience, is considered one of the founders of the field of neuroethics, which combines the disciplines of neuroscience and ethics. And Emory’s Center for Ethics, led by Wolpe, also has one of the leading neuroethics programs in the world.

Rommelfanger, Wolpe and others kicked off conversation in their monthly Neuroethics and Neuroscience in the News series about the ethics of the transplant and published a summary on AJOB-Neuroscience’s news blog, The Neuroethics Blog. The blog is the leading online neuroethics forum, with readership in 40 countries. Soon Sergio Canavero, the Italian surgeon leading the planned head transplant, was in touch and wanted to weigh in with his views.

“I received an email in my inbox from Canavero basically accusing me of not including him in the conversation and not fairly giving him a chance to speak. And he was absolutely right,” Rommelfanger says. 

Canavero and his team were invited to submit an article for AJOB-Neuroscience and the editorial team decided to build an entire issue of the journal around the ethics of head transplants.

Canavero’s team made their case, Wolpe wrote a rebuttal, and then leading neuroscientists were invited to react to the conversation. Then Canavero was given an opportunity to react to their reactions.

It was a robust discussion that tackled many of the thorny issues raised by head transplants.

For instance, when one person’s head is transplanted to another person’s body, is the individual whose head is transplanted the same person they were before the operation?

“The idea that you can just take someone’s head and just plop it on someone else’s body and it will be the same person is a theory. We take it for granted that it’s true but it’s certainly not taken for granted in other cultures or historically,” Wolpe says.

“In the West, we’re cerebro-centric — we believe that the brain constitutes the vast majority of who we are as human beings. It’s probably true but we really don’t know,” he adds.

Another issue that needs to be considered, according to Wolpe and Rommelfanger, is the safety of the patient. Transplant procedures are typically undertaken after years, if not decades, of careful research, including papers, animal models and meticulously practiced and documented surgical techniques.

“There’s no dimension on which this satisfies long-held research standards in medicine,” Wolpe says. “They’re just jumping right to a very complicated and difficult surgery in the absence of all the kind of background research information you’d normally have.”

And while the surgeons claim the patient is expected to have some mobility after the procedure, it’s unclear what quality of life might be possible for the patient.

The source of the body for the transplant, as well as the other patients who could have been saved with the functioning organs within that body, are also important to consider, says Rommelfanger. The extremely high cost of head transplants, even if possible, would exclude all but the very rich from undergoing the procedure, she adds.

Many of these ethical concerns have been brought up in relation to organ transplant procedures, but the scope of the problem when transplanting an entire body is ten-fold. Our culture’s disgust with swapping out body parts as if they were car parts is likely behind some of the outrage directed at the idea of the head transplant and at Canavero, the surgeon trying to make it happen, Rommelfanger says.

“Everyone knows the system is sick but Canavero is an easy target,” Rommelfanger says. “With or without him, the problem will still be there and we’ll have to do the hard work of looking at ourselves.”